Ever the trimmer, President Obama recently tried to calm Obamacare opponents by noting that his signature health initiative is a deeply Republican (c. 2005) policy:

[W]hen you actually look at the bill itself, it incorporates all sorts of Republican ideas. I mean, a lot of commentators have said . . . "this is sort of similar to the bill that Mitt Romney, the Republican governor and now presidential candidate, passed in Massachusetts." A lot of the ideas in terms of the exchange, just being able to pool and improve the purchasing power of individuals in the insurance market. That originated from the Heritage Foundation.

The Obama/Heritage disagreement suggests far more about political style than it does policy substance. The President tries to prove how moderate he is; the right responds with a renewed emphasis on its purity and principle. But elites on both side of the ideological divide agree that health care costs must be cut. The Affordable (not necessarily Quality, or Accessible) Care Act does that, reflecting the balance of power in the Washington that generated it.